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Salamanca J, Alfonso F. Takotsubo syndrome: unravelling the enigma of the broken heart syndrome?-a narrative review. Cardiovasc Diagn Ther 2023; 13:1080-1103. [PMID: 38162098 PMCID: PMC10753233 DOI: 10.21037/cdt-23-283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024]
Abstract
Background and Objective Takotsubo syndrome (TTS) is a condition characterized by transient ventricular regional wall motion abnormalities, without causative coronary artery disease, typically triggered by emotional or physical stress. TTS is more common in post-menopausal women, closely resembling acute coronary syndrome (ACS) in its clinical presentation, with multiple proposed underlying pathophysiological mechanisms and no evidence-based treatments. This review aims to provide a comprehensive summary of the latest research, encompassing the pathophysiology, diagnostic findings, prognosis, and treatment options for TTS patients. Methods Relevant literature from 1990 to June 2023 on TTS epidemiology, physiopathology, diagnosis, clinical manifestations, treatment, and prognosis was retrieved through PubMed research. Only English publications were included. Key Content and Findings TTS is an increasingly recognized cardiovascular disorder, a significant release of catecholamines is thought to be a key contributing element, yet its exact mechanism remains unclear. Notably, TTS poses significant short and long-term risks akin to ACS. Initial treatment should focus on ruling out ACS and providing standard care for subsequent left ventricular dysfunction and complications. Research hints at a potential role for Angiotensin-converting enzyme inhibitors and Angiotensin II receptor blockers in improving long-term prognosis in TTS patients. Conclusions Significant knowledge gaps still exist in our understanding of the pathophysiology, treatment options, and areas for improvement in diagnosing and prognosticating this intriguing condition. Further research is therefore needed.
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Affiliation(s)
- Jorge Salamanca
- Cardiology Department, La Princesa University Hospital, Princesa Institute for Health Research (IIS-IP), Autonomous University of Madrid, CIBERCV, Madrid, Spain
| | - Fernando Alfonso
- Cardiology Department, La Princesa University Hospital, Princesa Institute for Health Research (IIS-IP), Autonomous University of Madrid, CIBERCV, Madrid, Spain
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Lu R, Lu M, He S, Lu J, Liao Y, Cui T, Wang M. Case report: Takotsubo syndrome following percutaneous coronary intervention. J Cardiothorac Surg 2023; 18:335. [PMID: 37974263 PMCID: PMC10655480 DOI: 10.1186/s13019-023-02412-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Takotsubo syndrome (TTS), which is frequently secondary to severe emotional (fear, anxiety, etc.) or physical stress, is an acute reversible heart failure syndrome characterized by temporary left ventricular regional systolic dysfunction. Nevertheless, TTS after percutaneous coronary intervention (PCI) is rare, and its clinical characteristics are easily confused with complications after PCI. CASE PRESENTATION This article reports a case of TTS induced by psychological and physical pressure after successful PCI in our institution. The patient had symptoms comparable to complications after PCI, including V1-V5 ST segment elevation and T wave changes of electrocardiogram (ECG) and troponin elevation. Coronary angiogram, left ventricle opacification (LVO), and cardiac magnetic resonance (CMR) were performed to exclude postoperative complications. Diagnosis of TTS was eventually achieved. CONCLUSION We cannot dismiss the risk of TTS in patients who have unexplained V1-V5 ST segment elevation and T wave changes of ECG and troponin elevation following successful PCI. Meanwhile, medical personnel should provide mental, cultural, and emotional services to patients in addition to essential diagnostic and treatment technical services during the perioperative period.
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Affiliation(s)
- Rui Lu
- Department of Vasculocardiology, The First Affiliate Hospital of Guang Zhou Medical University, Guangzhou, China
| | - Mingjun Lu
- Department of Vasculocardiology, The First Affiliate Hospital of Guang Zhou Medical University, Guangzhou, China
| | - Shangfei He
- Department of Vasculocardiology, The First Affiliate Hospital of Guang Zhou Medical University, Guangzhou, China
| | - Jing Lu
- Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Yi Liao
- Department of Vasculocardiology, The First Affiliate Hospital of Guang Zhou Medical University, Guangzhou, China
| | - Tongtao Cui
- Department of Vasculocardiology, The First Affiliate Hospital of Guang Zhou Medical University, Guangzhou, China
| | - Min Wang
- Department of Vasculocardiology, The First Affiliate Hospital of Guang Zhou Medical University, Guangzhou, China.
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Zhang ZY, Sun JJ, Wang JH, Wang P, Liu BM, Xing JH, Liu J, Zhang DP, Kong ZZ, Zhang HT, Yu XY. Successful treatment of a severe Takotsubo syndrome case complicated by liver abscess. BMC Cardiovasc Disord 2023; 23:189. [PMID: 37038117 PMCID: PMC10088135 DOI: 10.1186/s12872-023-03145-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/20/2023] [Indexed: 04/12/2023] Open
Abstract
The main manifestations of Takotsubo syndrome (TTS) are a spherical expansion of the left ventricle or near the apex and decreased systolic function. TTS is mostly thought to be induced by emotional stress, and the induction of TTS by severe infection is not often reported. A 72-year-old female patient with liver abscess reported herein was admitted due to repeated fever with a history of hypertension and impaired glucose tolerance. Her severe infection caused TTS, and her blood pressure dropped to 80/40 mmHg. IABP treatment was performed immediately and continued for 10 days, and comprehensive medication was administered. Based on her disease course and her smooth recovery, general insights and learnings may be: Adding to mental and other pathological stress reaction, serious infections from pathogenic microorganism could be of great important causation of stress reaction leading to TTS, while basic diseases such as coronary heart disease, hypertension, and diabetes were be of promoting factors; In addition to effective drug therapies for TTS, the importance of the timely using of IABP should be emphasized.
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Affiliation(s)
- Zhi-Yue Zhang
- Department of Cardiology, Air Force Medical Center, 100142, Beijing, China
- Hebei North University, Zhangjiakou, 075000, Hebei, China
| | - Jin-Jin Sun
- Department of Cardiology, Air Force Medical Center, 100142, Beijing, China.
| | - Jun-Hua Wang
- Department of Cardiology, Air Force Medical Center, 100142, Beijing, China.
| | - Peng Wang
- Department of Cardiology, Air Force Medical Center, 100142, Beijing, China
| | - Bai-Mei Liu
- Department of Cardiology, Air Force Medical Center, 100142, Beijing, China
| | - Jun-Hua Xing
- Department of Cardiology, Air Force Medical Center, 100142, Beijing, China
| | - Jun Liu
- Department of Research, Air Force Medical Center, 100142, Beijing, China
| | - Da-Peng Zhang
- Department of Cardiology, Air Force Medical Center, 100142, Beijing, China
| | - Zhen-Zhen Kong
- Department of Cardiology, Air Force Medical Center, 100142, Beijing, China
| | - Hai-Tao Zhang
- Department of Cardiology, Air Force Medical Center, 100142, Beijing, China
| | - Xin-Ya Yu
- Department of Cardiology, Air Force Medical Center, 100142, Beijing, China
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Huang X, Guan B, Ma Y, Tian F, Yu Y, Luo Y, Li Y, Cao J, Deng Y. Values of new ultrasonic imaging methods for the diagnosis of apical Takotsubo syndrome. Quant Imaging Med Surg 2023; 13:1323-1335. [PMID: 36915330 PMCID: PMC10006141 DOI: 10.21037/qims-21-1108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/03/2022] [Indexed: 12/15/2022]
Abstract
Background Takotsubo syndrome (TTS) is a multifactorial disease contributed to by several pathological factors. It is characterized by transient left ventricular dysfunction, and patients with TTS can spontaneously recover within days or weeks. This study's objective was to investigate the ultrasonic characteristics of TTS during different periods and assess the clinical application value of real-time 3-dimensional echocardiography (RT-3DE) and speckle tracking imaging (STI) in TTS. Methods In this prospective cohort study, the patients with apical TTS were evaluated by echocardiography on admission (within 1-3 days) and after 4 and 8 weeks. RT-3DE was performed to observe the structure and function of the left ventricle (LV). LV end-diastolic volume (LVEDV), end-systolic volume (LVESV), stroke volume (LVSV), and ejection fraction (LVEF) were calculated. The longitudinal peak systolic strain (LPSS) of all LV myocardial segments was acquired by 2D STI. For comparison, 20 healthy individuals were included as normal controls. Results A total of 16 patients with TTS were included. Their LV was characterized as an "octopus pot" in morphology with obvious hypokinesis on admission. The LVEDV, LVESV, LVSV, and LVEF were 84.23±10.67, 55.94±8.51, 28.31±8.06 mL, and 33.59%±4.12%, respectively, in patients with TTS on admission with a significant difference from those of the controls (P=0.005, P<0.001, P<0.001, and P<0.001, respectively). A definite improvement was found upon follow-up, with these parameters even returning to normal morphology after 8 weeks. The LVEDV, LVESV, LVSV, and LVEF were 75.79±6.86, 28.05±4.33, 47.81±3.57 mL, and 63.02%±3.92%, respectively, in TTS patients after 8 weeks with no significant difference from those of the controls (P=0.907, P=0.235, P=0.162, and P=0.052, respectively). A significant decrease in LPSS was also found in patients with TTS on admission. In the eighth week of follow-up, the LPSS of the apical and middle segments in TTS patients remained significantly decreased compared with that of the normal controls (-18.54%±4.69% vs. -24.29%±3.46%, P<0.001; -19.38%±2.88% vs. -22.36%±3.23%, P<0.001), but that of the basal segments in TTS patients returned to normal and there was no significant differences from the normal controls (-20.75%±2.91% vs. -21.51%±2.85%; P=0.055). Conclusions RT-3DE and STI played an indispensable role in visually and quantitatively inspecting the abnormalities of patients with TTS, including in diagnosis and follow-up.
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Affiliation(s)
- Xin Huang
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Bo Guan
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Yufei Ma
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Fan Tian
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Yan Yu
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yue Li
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jian Cao
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Yujiao Deng
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China.,Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
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Lin Q, Fu Y, Chen Y, Zang X, Liu L. Misdiagnosed takotsubo syndrome: a case report. Ann Palliat Med 2021; 11:1826-1832. [PMID: 34263611 DOI: 10.21037/apm-21-855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/23/2021] [Indexed: 11/06/2022]
Abstract
Takotsubo syndrome (TTS) is characterized by acute and transient dysfunction of the apical segment of the left ventricle. In recent years, there have been increasing numbers of case reports about TTS; however, it is still being neglected and misdiagnosed in many primary hospitals in China. We present a case of a 68-year-old female who presented to our hospital with one month of paroxysmal cough. Here severe cough would sometimes induce headache, chest pain, nausea, and vomiting. She had an unexplained cardiogenic shock approximately 4 months prior and gradually developed orthopnea. Cardiac biomarkers were mildly elevated, and electrocardiogram (ECG) displayed diffuse and deep T-waves inversion in leads I, II, AVL, and V2-V9, like acute myocardial infarction. However, coronary angiography was performed and showed the absence of obstructed coronary atherosclerosis or acute plaque rupture. The patient was successively treated in four hospitals and was eventually diagnosed with TTS in our hospital (the fourth hospital) due to noncardiogenic discomfort. Physicians at some primary hospitals require additional clinical experience to deeply understand TTS. Many doctors could learn about TTS from a medical textbook but remain unfamiliar with the disease. We hope that through analysis of this case, primary doctors will have a deeper understanding of TTS, avoid misdiagnosing the typical cases that occur in their patients.
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Affiliation(s)
- Qiuzhen Lin
- Department of Cardiovascular Medicine, the Second Xiangya Hospital, Central South University, Changsha, China; Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, China; Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, Changsha, China; Cardiovascular Disease Research Center of Hunan Province, Changsha, China
| | - Yan Fu
- Department of Cardiovascular Medicine, the Second Xiangya Hospital, Central South University, Changsha, China; Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, China; Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, Changsha, China; Cardiovascular Disease Research Center of Hunan Province, Changsha, China
| | - Yanqiao Chen
- Department of Cardiovascular Medicine, the Second Xiangya Hospital, Central South University, Changsha, China; Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, China; Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, Changsha, China; Cardiovascular Disease Research Center of Hunan Province, Changsha, China
| | - Xueyan Zang
- Department of Cardiovascular Medicine, the Second Xiangya Hospital, Central South University, Changsha, China; Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, China; Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, Changsha, China; Cardiovascular Disease Research Center of Hunan Province, Changsha, China
| | - Ling Liu
- Department of Cardiovascular Medicine, the Second Xiangya Hospital, Central South University, Changsha, China; Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, China; Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, Changsha, China; Cardiovascular Disease Research Center of Hunan Province, Changsha, China
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Kummer M, El-Battrawy I, Gietzen T, Ansari U, Behnes M, Lang S, Zhou X, Borggrefe M, Akin I. The Use of Beta Blockers in Takotsubo Syndrome as Compared to Acute Coronary Syndrome. Front Pharmacol 2020; 11:681. [PMID: 32477140 PMCID: PMC7240099 DOI: 10.3389/fphar.2020.00681] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 04/27/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Takotsubo syndrome (TTS) and acute coronary syndrome (ACS) patients have a similar mortality rate. In this study, we sought to determine the short- and long-term outcome of TTS patients as compared to ACS patients both treated with beta-blockers. OBJECTIVES In the present study we described the data of 5 years of follow up of 103 TTS and 422 ACS patients both treated with beta-blockers. METHODS Data from TTS patients were included retrospectively and prospectively, ACS patients were included retrospectively. All retrospectively included patients have been followed up for 5 years. The end point in this study was the occurrence of death. RESULTS TTS affected significantly more women (87.4%) than ACS (34.6%) (p < 0.01). TTS patients suffered significantly more often from thromboembolic events (14.6% versus 2.1%; p < 0.01) and cardiogenic shock (11.9% versus 3.6%; p < 0.01) than the ACS group. TTS patients had a significantly higher long-term mortality (within 5 years) as compared to ACS patients (17.5% versus 3.6%) (p < 0.01). Patients of the TTS group compared to the ACS group did not benefit from combination of beta-blockers and ACE-inhibitors in terms of long-term mortality (p < 0.01). As we compare TTS patients who were treated with beta-blockers and ACE-inhibitors versus single use of beta-blockers there was no difference in long-term mortality (p = 0.918). CONCLUSION TTS patients had a significantly higher long-term mortality (within 5 years) than patients with an ACS.
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Affiliation(s)
- Marvin Kummer
- First Department of Medicine, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim El-Battrawy
- First Department of Medicine, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Thorsten Gietzen
- First Department of Medicine, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Uzair Ansari
- First Department of Medicine, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - Siegfried Lang
- First Department of Medicine, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Xiaobo Zhou
- First Department of Medicine, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
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